IM NBME Form 2 Exam Questions and
Answers
62 iiyo ii- iiL.hemiparesis iiresolves iicompletely iiin ii2 iihrs ii
BP: ii140/90 iimmHg
PE: iiR.carotid iibruit ii
ECG, iiCBC, iihead iiCT ii- iigucci
next iistep iiin iidx? ii- iiAnswers ii-duplex iiultrasonography iiof iithe iicarotid iiarteries ii
probably iihad iiTIA
> iilasts iibet iifew iiminutes ii- ii24 iihrs ii
> iisymptoms iitransient iibc iirepercussion iioccurs ii- iieither iifrom iicollateral iicirculation iior
iibreaking iiup iiof iian iiembolus ii
> iiusually iiembolic ii
> iialthough iitransient iiHoTN iiin iipresence iiof iisevere iicarotid iistenosis ii(>75%) iican iilead
iito iiTIA ii
screen iiall iipts iiw/ iicarotid iiduplex iiUS iiwho iihave iicarotid iibruit, iiPVD, iiand/or iiCAD
62 iiyo ii- ii3 iimonths iiof iimildly iiinc iiSOB
PMHx: ii3 iiyrs iiof iiCOPD ii
SHx: iismokes ii1 iipack iiqd iifor ii40 iiyrs ii- iiquit ii3 iiyrs iiago iiwhen iidx ii
RR: ii16/min
BP: ii138/76 iimmHg
pulm iiexam: iimildly iidec iiair iimovement; iioccasional iiwheeze ii
ABG: iipH, iipCO2 ii- iiWNL; iidec iiPO2 ii(74)
next iistep iiin iimgnt? ii- iiAnswers ii-ipratropium iitherapy ii
tx iiCOPD iiw/ iibronchodilators
> iisince iialbuterol iiisn't iian iioption ii> iichoose iianother iibronchodilator ii(antichol iidrug) ii
give iisteroids iiand iiABs iifor iiacute iiexacerbations
67 iiyo ii- ii3 iidays iiof iifever, iicough iiproductive iiof iidark iisputum, iipleuritic iichest iipain,
iiSOB ii
> iiprior iito iithese iisymptoms: iirunny iinose, iinasal iicongestion, iimild iisore iithroat ii
101.2 iiF
P: ii92/min
RR: ii18/min
BP: ii146/86 iimmHg
PE: iibronchial iibreath iisounds iiin iiLLL, iidullness iito iipercussion
CXR: iiLLL iiinfiltrate; iipleural iieffusion ii
thoracentesis: iiyellow iifluid ii
labs:
> iiserum: iiglucose ii(105), iiprotein ii(7.2), iiLDH ii(55) ii
,> iipleural iifluid: ii1025 iiRBC, ii3500 iiWBC ii(90% iisegs), iiglucose ii(80), iiprotein ii(6.5), iitriG
ii(30), iiamylase ii(30), iiLDH ii(95), iipH ii6.9 ii
gram iistain: iiseg iineutrophils iiand iigram iipos iidiplococci ii
cx iiof iifluid: iipending ii
most iilikely iidx? ii- iiAnswers ii-empyema ii
pus ii+ iigram iistain iiw/ iibacteria ii
use iiLight's iicriteria iito iiconfirm iiexudate: ii
> iiPprotein:Sprotein ii> ii0.5 ii
> iiPLDH: iiSLDH ii> ii0.6 ii
> iipleural iifluid iiLDH ii> ii2/3x iiupper iilimit iiof iinormal iifor iiserum
42 iiyo ii- ii1 iimonth iiof iiprog iiSOB
> iino iifever, iicough iiproductive iiof iipurulent/blood-tinged iisputum ii
> iireceiving iichronic iiO2 iifor iitx iiof iidyspnea
SHx: iino iismoking ii
FHx: iiyounger iibro ii- iisingle iilung iitransplant iifor iiCOPD ii(1 iiyr iiago)
BMI: ii20 ii
RR: ii24/min
PE: iibreath iisounds iidec; iiBL iibasilar iicrackles ii
CXR: iihyperlucent iilung iifields iimost iiprominent iiat iibases; iiflattened iidiaphragms
most iilikely iiexplanation iifor iifindings? ii- iiAnswers ii-abnormality iiof iiantiprotease
iiresulting iiin iidestruction iiof iialveolar iisupporting iistructures ii
alpha1 iiantitrypsin iidef ii
CXR: iiflattened iidiaphragms ii= iiCOPD
FHx ii+ iiSHx iineg iifor iicig iismoking ii= iisuggests iiemphysema iias iicause iifor iipt's iiCOPD ii
panacinar iiemphysema ii(enzyme iidef) ii- iilower iilobes iidestruction iigreater ii
> iicentro-acinar ii(smoking iiinduced) ii- iiupper iilobes
54 iiyo ii- iiinc iiSOB iiand iiankle iiswelling iifor ii3 iiwks ii
> iinonproductive iicough/discomfort iiwhen iisleeping iion ii< ii4 iipillows ii
PMHx: iiDM
PE: iiS3 iiw/ iidullness iito iipercussion; iidec iibreath iisounds iiat iibase iiof iiR.hemithorax ii
most iilikely iifinding iion iiexam iiof iipleural iifluid? ii- iiAnswers ii-glucose iiconcentration
iiapproximately iiequal iito iiserum iiglucose iiconcentration ii
S3 iipresent ii= iiHF ii
pleural iieffusion iifrom iiHF iiwould iibe iitransudative iiso iipick iithe iianswer iiwhich
iiexemplifies iithis
cardiac iiinsuff ii= iitransudate
low iiglucose ii= iiexudate
27 iiyo ii- iihip iipain iifor ii2 iimonths ii
> iimost iisevere iiw/ iiweight iibearing ii
> iiwalks iiw/ iimarked iilimp
> iiPROM/AROM iiof iihip iicauses iipain ii
meds: iiibuprofen ii(HA); iimethylprednisolone ii(SLE) ii
X-ray iiof iihips iishown ii- iiR.sided iicrescent iisign ii
, most iilikely iidx? ii- iiAnswers ii-osteonecrosis ii
one iiof iithe iibiggest iiSE iiof iisteroids iiis iiosteonecrosis ii
crescent iisign ii= iiavascular iinecrosis
47 iiyo ii- iiroutine iiexam
PMHx: iiT2DM ii(6 iiyrs ii- iiglipizide) ii
BP: ii138/88 iimmHg
PE ii(skin/neuro): iigucci ii
labs: iiHgA1C ii5.8%; iiglucose iifasting ii132; iiCr ii1; iichol ii170; iiHDL ii45; iiLDL ii95; iitriG
ii150 ii
UA: iiWNL
the iiaddition iiof iiwhat iimed iiwould iidec iipt's iirisk iifor iidiabetic iicomplications? ii- iiAnswers
ii-enalapril ii
ACEi ii- iiprotective iiagainst iidiabetic iiglomerulonephropathy
all iipts iiw/ iiDM iiget iiACEi ii(even iiin iiabsence iiof iiHTN)
who iineeds iia iistatin? ii(since iithis iiis iian iianswer iichoice)
1. iivasc iidz ii(MI, iiCVA, iiPVD, iiCS)
2. iiLDL ii> ii190
3. iiLDL ii70-189 ii+ iiage ii+ iidiabetes ii
> iiso iitechnically iishe iishould iihave iigotten iione ii
4. iiLDL ii70-189 ii+ iiage ii+ iicalculated iirisk ii(RFs)
48 iiyo ii- iiupper iiabd iipain, iin/v iifor ii2 iidays
> iiproductive iicough ii- ii3 iimonths
PMHx: iialcoholism
SHx: iidrinks ii12 iipack iiqd; iismokes ii2 iipacks iiqd iifor ii30 iiyrs
101.1F
P: ii120/min
BP: ii90/55mmHg
PE: iicoarse iibreath iisounds; iitenderness iiw/ iivoluntary iiguarding iiin iiLUQ; iibowel
iisounds iiabsent ii
occult iiblood iipos ii
labs: iidec iiCa ii7.6, iialbumin ii3.5 ii
most iilikely iidx? ii- iiAnswers ii-pancreatitis ii
presents iiw/ iifever, iitachycardia, iiHoTN, iiabd iitenderness ii
alcoholism iiinc iirisk ii
GIB ii- iiseen iiin iisevere iipancreatitis ii
hypoCa ii- iidue iito iisaponification iirxn iiin iipancreas ii
LUQ iipain iibc iipancreatitis iican iicause iisplenic iivein iithrombosis ii???
42 iiyo ii- iinewly iidx iiPKD ii
asks iiif iiany iiof iiher ii3 iikids iiwill iiinherit iiPKD
> iiparents, ii3 iisiblings, iiand iihusband iidon't iihave iithis iidisorder ii
what iiis iithe iirisk iifor iiPKD iiin iiher iikids? ii- iiAnswers ii-50% iifor iieach iichild, iisince iiPDK
iiis iiautosomal iidominant ii
even iithough iiher iiparents iididn't iihave iiit ii
Answers
62 iiyo ii- iiL.hemiparesis iiresolves iicompletely iiin ii2 iihrs ii
BP: ii140/90 iimmHg
PE: iiR.carotid iibruit ii
ECG, iiCBC, iihead iiCT ii- iigucci
next iistep iiin iidx? ii- iiAnswers ii-duplex iiultrasonography iiof iithe iicarotid iiarteries ii
probably iihad iiTIA
> iilasts iibet iifew iiminutes ii- ii24 iihrs ii
> iisymptoms iitransient iibc iirepercussion iioccurs ii- iieither iifrom iicollateral iicirculation iior
iibreaking iiup iiof iian iiembolus ii
> iiusually iiembolic ii
> iialthough iitransient iiHoTN iiin iipresence iiof iisevere iicarotid iistenosis ii(>75%) iican iilead
iito iiTIA ii
screen iiall iipts iiw/ iicarotid iiduplex iiUS iiwho iihave iicarotid iibruit, iiPVD, iiand/or iiCAD
62 iiyo ii- ii3 iimonths iiof iimildly iiinc iiSOB
PMHx: ii3 iiyrs iiof iiCOPD ii
SHx: iismokes ii1 iipack iiqd iifor ii40 iiyrs ii- iiquit ii3 iiyrs iiago iiwhen iidx ii
RR: ii16/min
BP: ii138/76 iimmHg
pulm iiexam: iimildly iidec iiair iimovement; iioccasional iiwheeze ii
ABG: iipH, iipCO2 ii- iiWNL; iidec iiPO2 ii(74)
next iistep iiin iimgnt? ii- iiAnswers ii-ipratropium iitherapy ii
tx iiCOPD iiw/ iibronchodilators
> iisince iialbuterol iiisn't iian iioption ii> iichoose iianother iibronchodilator ii(antichol iidrug) ii
give iisteroids iiand iiABs iifor iiacute iiexacerbations
67 iiyo ii- ii3 iidays iiof iifever, iicough iiproductive iiof iidark iisputum, iipleuritic iichest iipain,
iiSOB ii
> iiprior iito iithese iisymptoms: iirunny iinose, iinasal iicongestion, iimild iisore iithroat ii
101.2 iiF
P: ii92/min
RR: ii18/min
BP: ii146/86 iimmHg
PE: iibronchial iibreath iisounds iiin iiLLL, iidullness iito iipercussion
CXR: iiLLL iiinfiltrate; iipleural iieffusion ii
thoracentesis: iiyellow iifluid ii
labs:
> iiserum: iiglucose ii(105), iiprotein ii(7.2), iiLDH ii(55) ii
,> iipleural iifluid: ii1025 iiRBC, ii3500 iiWBC ii(90% iisegs), iiglucose ii(80), iiprotein ii(6.5), iitriG
ii(30), iiamylase ii(30), iiLDH ii(95), iipH ii6.9 ii
gram iistain: iiseg iineutrophils iiand iigram iipos iidiplococci ii
cx iiof iifluid: iipending ii
most iilikely iidx? ii- iiAnswers ii-empyema ii
pus ii+ iigram iistain iiw/ iibacteria ii
use iiLight's iicriteria iito iiconfirm iiexudate: ii
> iiPprotein:Sprotein ii> ii0.5 ii
> iiPLDH: iiSLDH ii> ii0.6 ii
> iipleural iifluid iiLDH ii> ii2/3x iiupper iilimit iiof iinormal iifor iiserum
42 iiyo ii- ii1 iimonth iiof iiprog iiSOB
> iino iifever, iicough iiproductive iiof iipurulent/blood-tinged iisputum ii
> iireceiving iichronic iiO2 iifor iitx iiof iidyspnea
SHx: iino iismoking ii
FHx: iiyounger iibro ii- iisingle iilung iitransplant iifor iiCOPD ii(1 iiyr iiago)
BMI: ii20 ii
RR: ii24/min
PE: iibreath iisounds iidec; iiBL iibasilar iicrackles ii
CXR: iihyperlucent iilung iifields iimost iiprominent iiat iibases; iiflattened iidiaphragms
most iilikely iiexplanation iifor iifindings? ii- iiAnswers ii-abnormality iiof iiantiprotease
iiresulting iiin iidestruction iiof iialveolar iisupporting iistructures ii
alpha1 iiantitrypsin iidef ii
CXR: iiflattened iidiaphragms ii= iiCOPD
FHx ii+ iiSHx iineg iifor iicig iismoking ii= iisuggests iiemphysema iias iicause iifor iipt's iiCOPD ii
panacinar iiemphysema ii(enzyme iidef) ii- iilower iilobes iidestruction iigreater ii
> iicentro-acinar ii(smoking iiinduced) ii- iiupper iilobes
54 iiyo ii- iiinc iiSOB iiand iiankle iiswelling iifor ii3 iiwks ii
> iinonproductive iicough/discomfort iiwhen iisleeping iion ii< ii4 iipillows ii
PMHx: iiDM
PE: iiS3 iiw/ iidullness iito iipercussion; iidec iibreath iisounds iiat iibase iiof iiR.hemithorax ii
most iilikely iifinding iion iiexam iiof iipleural iifluid? ii- iiAnswers ii-glucose iiconcentration
iiapproximately iiequal iito iiserum iiglucose iiconcentration ii
S3 iipresent ii= iiHF ii
pleural iieffusion iifrom iiHF iiwould iibe iitransudative iiso iipick iithe iianswer iiwhich
iiexemplifies iithis
cardiac iiinsuff ii= iitransudate
low iiglucose ii= iiexudate
27 iiyo ii- iihip iipain iifor ii2 iimonths ii
> iimost iisevere iiw/ iiweight iibearing ii
> iiwalks iiw/ iimarked iilimp
> iiPROM/AROM iiof iihip iicauses iipain ii
meds: iiibuprofen ii(HA); iimethylprednisolone ii(SLE) ii
X-ray iiof iihips iishown ii- iiR.sided iicrescent iisign ii
, most iilikely iidx? ii- iiAnswers ii-osteonecrosis ii
one iiof iithe iibiggest iiSE iiof iisteroids iiis iiosteonecrosis ii
crescent iisign ii= iiavascular iinecrosis
47 iiyo ii- iiroutine iiexam
PMHx: iiT2DM ii(6 iiyrs ii- iiglipizide) ii
BP: ii138/88 iimmHg
PE ii(skin/neuro): iigucci ii
labs: iiHgA1C ii5.8%; iiglucose iifasting ii132; iiCr ii1; iichol ii170; iiHDL ii45; iiLDL ii95; iitriG
ii150 ii
UA: iiWNL
the iiaddition iiof iiwhat iimed iiwould iidec iipt's iirisk iifor iidiabetic iicomplications? ii- iiAnswers
ii-enalapril ii
ACEi ii- iiprotective iiagainst iidiabetic iiglomerulonephropathy
all iipts iiw/ iiDM iiget iiACEi ii(even iiin iiabsence iiof iiHTN)
who iineeds iia iistatin? ii(since iithis iiis iian iianswer iichoice)
1. iivasc iidz ii(MI, iiCVA, iiPVD, iiCS)
2. iiLDL ii> ii190
3. iiLDL ii70-189 ii+ iiage ii+ iidiabetes ii
> iiso iitechnically iishe iishould iihave iigotten iione ii
4. iiLDL ii70-189 ii+ iiage ii+ iicalculated iirisk ii(RFs)
48 iiyo ii- iiupper iiabd iipain, iin/v iifor ii2 iidays
> iiproductive iicough ii- ii3 iimonths
PMHx: iialcoholism
SHx: iidrinks ii12 iipack iiqd; iismokes ii2 iipacks iiqd iifor ii30 iiyrs
101.1F
P: ii120/min
BP: ii90/55mmHg
PE: iicoarse iibreath iisounds; iitenderness iiw/ iivoluntary iiguarding iiin iiLUQ; iibowel
iisounds iiabsent ii
occult iiblood iipos ii
labs: iidec iiCa ii7.6, iialbumin ii3.5 ii
most iilikely iidx? ii- iiAnswers ii-pancreatitis ii
presents iiw/ iifever, iitachycardia, iiHoTN, iiabd iitenderness ii
alcoholism iiinc iirisk ii
GIB ii- iiseen iiin iisevere iipancreatitis ii
hypoCa ii- iidue iito iisaponification iirxn iiin iipancreas ii
LUQ iipain iibc iipancreatitis iican iicause iisplenic iivein iithrombosis ii???
42 iiyo ii- iinewly iidx iiPKD ii
asks iiif iiany iiof iiher ii3 iikids iiwill iiinherit iiPKD
> iiparents, ii3 iisiblings, iiand iihusband iidon't iihave iithis iidisorder ii
what iiis iithe iirisk iifor iiPKD iiin iiher iikids? ii- iiAnswers ii-50% iifor iieach iichild, iisince iiPDK
iiis iiautosomal iidominant ii
even iithough iiher iiparents iididn't iihave iiit ii
